The strategies to control pigmentation are manifold and include:
1. Avoidance of UV exposure and use of Medical Grade Cosmeceuticals
Singapore is a country just one degree north of the equator and the amount of ultraviolet exposure we receive is significant. To avoid this, outdoor activities in the sun should be timed where possible in the mornings and evenings. A good rule is to be in the sun when your shadow is longer than your height- before 10 am and after 4 pm. It is advisable to wear sunblock at all times. We use a water based SPF50 formulation for daily use and advise patients to use a thicker formulation for sporting activities for longer lasting protection. The medical grade cosmeceuticals that we recommend include hydroquinone, arbutin and high potency vitamin C preparations.
2. Reduction of Medications that may cause Pigmentation
The list of medications that cause pigmentation is lengthy and includes hormones such as estrogen, contraceptive preparations, antibiotics like tetracycline, amiodarone, antidepressants and some chemotherapy agents such as 5-flourouracil. It is important to consult your doctor before changing or stopping any of your medications as they may be essential to your treatment. In this case, one may need to accept the pigmentation as of secondary concern.
3. Treatment of flat pigment with Broadband Light Sources and Lasers
Pigment that is flat and not raised above the skin can be treated with a variety of light based therapies. These include broadband light therapies like Sciton BBL and Aurora SR-A and DS. More stubborn pigmentation can be treated with Q- switched Nd YAG and long pulse Nd YAG lasers. The doctor needs to balance the colour of the condition relative to the native colour of the patient’s skin when choosing the power setting and pulse type of each of these therapies.
4. Treatment of raised pigmented lesions with Lasers or Surgical Excision
Pigmentation which is raised above the surface of the skin usually requires an ablative laser system to treat it. These include sebbhoeric keratoses and small pigmented neavi. These can be treated with erbium lasers and CO2 lasers. In the case of pigmented neavi, it is necessary to remove both the neavus and its deeper extension. Smaller neavi can be treated with the CO2 laser. With larger neavi, a laser may leave a depressed scar so surgical excision is preferred. This will also allow the tissue removed to be sent for analysis.
5. Treatment of suspicious pigmented lesions with Biopsy and Surgical Excision and Reconstruction as necessary
In some instances, the pigmented lesion may exhibit other features that lead us to advise a biopsy. This is to exclude more dangerous lesions like basal cell carcinomas (BCC), squamous cell carcinomas (SCC) and melanomas. Once the diagnosis is confirmed, further excision may be required. In larger lesions, reconstruction with a flap or skin graft may be required. Additional adjuvant therapy may also be required.
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